NURSE LEADERSHIP Developing the Workforce of the Future SPONSORED BY: THE PATH FORWARD... Investing in nurse education and development is critical for hospitals and health systems to successfully transition to value-based care. Nurses are in a position to not only partici- pate in, but lead the transformation of the health care delivery system to one that is focused on team-based, patient-centered care across the continuum. This transformation will require new skills and enhanced knowledge around population health, wellness and data analytics, among other things. This executive dialogue explores the nursing workforce of the future, including the necessary composition and distribution of the nursing workforce. It examines the nursing supply chain and what is needed to educate and retain a suf- ficient workforce; how health care provider organizations can recognize, support and train nurse leaders; and the barriers to nurse advancement. 2 EXECUTIVE DIALOGUE | Sponsored by Walden University | 2019 PANELISTS ▶ Donna Frazier, R.N. CHIEF NURSING OFFICER THE PANELISTS MERCY HOSPITAL SOUTH ST. LOUIS, MO. ▶ Lisa Gossett, R.N. SENIOR VICE PRESIDENT AND CHIEF NURSING EXECUTIVE OHIOHEALTH, COLUMBUS, OHIO ▶ Julie Lindeman-Read, R.N. SENIOR DIRECTOR, NURSING PRACTICE AND TRANSFORMATIONAL LEADERSHIP KAISER PERMANENTE NATIONAL PATIENT CARE SERVICES, FREMONT, CALIF. ▶ Betsy Patterson, R.N. VICE PRESIDENT & REGIONAL CHIEF NURSE EXECUTIVE OFFICER BAYLOR SCOTT & WHITE, HILL COUNTRY REGION LEANDER, TEXAS ▶ Jan Phillips, D.N.P., R.N. CHIEF NURSING EXECUTIVE CENTRAL CAROLINA HOSPITAL, SANFORD, N.C. ▶ George Zangaro, Ph.D., R.N. ASSOCIATE DEAN SCHOOL OF NURSING WALDEN UNIVERSITY, MINNEAPOLIS, MINN. MODERATOR ▶ Lee Ann Jarousse SENIOR EDITOR, AHA CENTER FOR HEALTH INNOVATION AMERICAN HOSPITAL ASSOCIATION, CHICAGO 3 EXECUTIVE DIALOGUE | Sponsored by Walden University | 2019 NURSE LEADERSHIP | Developing the Workforce of the Future MODERATOR (Lee Ann Jarousse, American Hospital to offer. We are always working on how to sell the Association): What are the challenges you face in community hospital experience. Our turnover rate recruiting and retaining a nurse workforce? is declining, and we’ve worked hard to reduce that. But the bigger battle is getting the nurses to our or- BETSY PATTERSON, R.N. (Baylor Scott & White Health): ganization, not keeping them. There’s a lot of loyalty In central Texas, there’s literally a war on talent. We to the community, which plays to our favor. But the have nurses who will jump ship and go down the challenge is attracting people to come to Sanford street to the next company for a small incentive. when Raleigh is 30 minutes down the road. Building loyalty and engagement so they want to stay long term is challenging. JULIE LINDEMAN-READ, R.N. (Kaiser Permanente): I work for the Kaiser Permanente program office, LISA GOSSETT, R.N. (OhioHealth): We need to find Kaiser’s national office. We have seven regions. ways to engage the younger workforce to build Some of our regions own their hospitals, while loyalty and leverage the skill sets and talent they others contract with other hospitals. Our challeng- bring to us. We need to give them a voice, so they es vary by region, but I’ll speak about California be- can help us change and innovate. By embracing cause I know that market best. Obtaining bedside the younger team members, we can learn a great nurses, in general, is not a huge challenge for us. deal. They bring a unique perspective. But in areas where the cost of living is high, it is harder to recruit. We are also expanding into other DONNA FRAZIER, R.N. (Mercy Hospital South): The regions and opening clinics, so that adds to our biggest challenge we face is recruitment. Our turn- staffing needs. Our turnover rates are low. over rate is decent, about 10 percent. But we con- tinually have to recruit. At one point, we had about Recruiting and retaining nurse leaders, particularly 100 positions open. In St. Louis, it’s a competitive inpatient department managers and assistant man- environment with multiple hospital systems having agers, is a focus for us. The challenges of managing to draw from the same pool of nurses. Our chal- a 24/7 operational department sometimes contrib- lenge is getting them in the door. Once they apply, ute to individuals in these roles seeking other op- our hiring rate is pretty high. It’s just the fact that portunities in the organization. A robust program for there is a limited supply and such a great demand. manger onboarding and development opportunities are in place to support managers. MODERATOR: Do you have certain specialty areas that are harder than others? MODERATOR: What about in terms of the pipe- line in your areas? Do you feel you have adequate FRAZIER: For some reason, our step-down units support in working with universities and commu- have the highest vacancy rate. Our operating nity colleges? rooms (ORs) have a low vacancy rate, which is a little unusual. PATTERSON: We do not in my region, which is out- side of Austin. We don’t have a feeder university, JAN PHILLIPS, R.N. (Central Carolina Hospital): Re- so we’re challenged with maintaining that pipeline. cruitment is a challenge for us. We are located about 30 minutes southwest of Raleigh in a rural environ- GOSSETT: We have a fairly robust pipeline in cen- ment. We are a 137-bed community hospital. We tral Ohio. We have strong support from our local can’t really compete with what DukeHealth, UNC nursing programs. Our regional care sites have Health Care or WakeMed Health & Hospitals have more of a challenge. They do not have the concen- 4 EXECUTIVE DIALOGUE | Sponsored by Walden University | 2019 NURSE LEADERSHIP | Developing the Workforce of the Future tration of high-acuity patients and, therefore, have what they have in California. In the past, a nurse a more difficult time maintaining the specialized felt that he or she had arrived when landing a posi- skill set to care for the critical care patients. tion in critical care, labor and the operating room. FRAZIER: We have quite a few nursing schools FRAZIER: Now you can be a graduate nurse and and programs in St. Louis. We partner with about work in those areas. It used to be that you had to nine schools for nursing clinicals, but those same work a couple of years in another practice area students whom we see are also being courted by before you could move into those positions. other hospitals. At times, it’s simply a price war. New grads are choosing an organization because On the subject of experienced nurses, we exper- it offers 50 cents to a $1 more an hour. Even with a imented with length of shift to see whether that robust pipeline, it comes down to pay and benefits. would make a difference. The feedback from our nurses was that nobody wanted to work 12-hour GEORGE ZANGARO, R.N. (Walden University): Lisa shifts. We posted eight-hour shifts and never got a touched on experienced nurses. We have an aging bite. No one wants them because they don’t want nurse workforce and the leading economists for to give up their four days off. They would rather nursing are expressing concern because we’re muddle through the 12-hour shifts. going to lose many years of experience. What are PHILLIPS: The problem is that it’s not sustainable as you age. That’s part of the challenge. An organi- zation for which I used to work did a combination “We have strong support from our local nursing of eight- and 12-hour shifts. It worked well. Nurses programs.”— Lisa Gossett would work two eight- and two 12-hour shifts. Monday, Wednesday and Friday were eight-hour days, and Sunday, Tuesday, Thursday and Saturday were 12 hours. That way, we never had a four- you doing in your organizations to train new peo- hour block to fill. It just worked. Nobody wants to ple and develop nurse leaders? Are you doing any do that anymore because that’s one less day off succession planning? This is going to be a huge a week. Another challenge we have is that many problem for nursing, not only losing people, but nurses have more than one job at two different losing years of experience. hospitals and manage schedules in two different places. That impacts longevity, because that’s not PATTERSON: I was at a conference recently and sustainable either. heard that 80% of med-surg nurses have fewer than two years of experience. That’s an eye opener. LINDEMAN-READ: We have many nurses who hold part-time positions with us and who also GOSSETT: We are looking at creative care models, regularly work in another organization in a status partnering novice and experts so there a knowl- position. In northern California, our nursing con- edge exchange. We are focusing on partnering tract guarantees set schedules. If a nurse works more and working in teams to take care for groups Tuesday, Thursday and Saturday one week and of patients. This is more challenging than it sounds Monday and Wednesday the next week, we can’t as many nurses are not comfortable managing a change that without going through the seniority team of other caregivers. The destination positions process and asking everybody else to change. It that Julie is talking about just doesn‘t exist like creates some limitation. 5 EXECUTIVE DIALOGUE | Sponsored by Walden University | 2019 NURSE LEADERSHIP | Developing the Workforce of the Future FRAZIER: One thing that has helped us maintain residency program for new graduates and we our experienced nurses who are no longer willing have clinical coaches who support them through or able to work 12-hour shifts is to move them to the program.